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PubMed1991

Unrelated bone marrow transplantation in Canada, the national experience.

The Canadian Unrelated Bone Marrow Donor Registry (UBMDR) of the Canadian Red Cross Society (CRCS) Blood Transfusion Service (BTS) was officially funded as of April 1, 1989 for an initial three year period with a mandate to recruit 50,000 unrelated bone marrow donors and conduct the search activities for unrelated bone marrow donors worldwide on behalf of Canadian patients (1). All provinces of Canada agreed to fund the Registry and it was unanimously adopted to locate the Canadian National Coordinating Centre (CNCC) of the Registry in Vancouver. Since February of 1988, 64 unrelated bone marrow transplants have been carried out in Canada. Over half of the unrelated donors have come from other countries. Canada has established working relationships with the United States, the United Kingdom and France. Recruitment of unrelated bone marrow donors is now established in twelve Canadian cities with more to follow. It is anticipated that the size of the registries world wide will continue to increase, that their ethnic makeup will become diversified and that the indications for unrelated bone marrow transplantation will broaden in the years to come.

Bone Marrow Transplantation↗
PubMed2003

New tainted-blood class actions in Québec and Alberta.

In two cases in Québec and Alberta, people infected with HIV and HCV through infected blood and blood products have successfully defended motions to strike out all or parts of their legal actions against federal and provincial governments and the Canadian Red Cross Society (CRCS). On 16 January 2003, the Québec Superior Court ruled that the plaintiffs in a class action could rely on the Krever Commission Report in their application for certification of a class proceeding. On 20 February 2003, the Alberta Court of Queen's Bench dismissed an application brought by the Canadian and Alberta governments to strike out the legal action brought against them. These cases illustrate that the settlement schemes proposed by the federal and provincial governments and the CRCS, and approved by the courts, have not put an end to the civil and constitutional claims brought by people seeking compensation for infection through tainted blood.

Alberta↗
PubMed2004

Blurring the boundaries of space: shaping nursing lives at the Red Cross outposts in Ontario, 1922-1945.

Historians and other scholars interested in the history of hospitals have investigated the links between medical architecture and the organization of space with the evolution of modern medicine. The transformation over time in the architectural for of medical institutions has tended to reflect developments in medical science and therapeutic efficiency as well as elements in the broader social climate. Some authors, however, have argued for the agency of structure and spatial organization, to consider that they are not just containers with which human activities take place, but which also actively construct or constitute social practices and relations. Most studies of this nature have centred on large medical buildings especially in urban areas, and have examined the impact of architectural arrangement in relation to administrators and architects, physicians and patients. Fe have considered the interconnections of form and space with nurses, despite the prominence of institutional nursing labour since the late 19th-century. The following discussion begins an exploration of these concepts within the rural environment. Between 1922 and 1984, the Ontario Division of the Canadian Red Cross Society administered an outpost program in which it operated small hospitals and nursing stations in isolated communities throughout the northern reaches of the province. This article will focus primarily o n the one-nurse stations that the Division managed during the interwar years and the nurses that it hired to staff them. The interior spatial organization of these outposts, which led in particular to their multiple functions as tiny hospitals, community health centres and nurses' homes, not only shaped both the professional practice and the social or private lives of the Red Cross nurses but also contributed to the diffusion of contemporary precepts in health and medical care throughout a remote population.

Architecture↗
PubMed1988

Logistics of automated plasma collection.

Plasmapheresis is widely carried out to produce plasma for fractionation. Production of Factor VIII and albumin, two proteins in plasma, drives the plasma industry. The Canadian Red Cross would like to achieve national self-sufficiency in plasma production to meet the rising demands for these proteins in the next 4 years. In order to achieve this goal we must make efficient use of our automated plasmapheresis machines and available human resources to produce a cost-effective plasma product. An assessment was undertaken at the Ottawa Centre to evaluate the number of procedures which could be performed on each machine per day and the staff required to operate these machines safely and efficiently. Donor availability, reliability and reasons for donating plasma were recorded to determine if our population could support such an escalated programme. Donor/staff interest and acceptance of automated equipment was determined. The results showed that four automated plasmapheresis devices could be operated by one nurse and one clinic assistant processing 32 donors a day with an average time of 27 min required for a 500-ml donation of plasma. The donor population was available and extremely interested; however, the logistics of scheduling proved to be an area for concern requiring special attention.

Autoanalysis↗
PubMed1991

Analysis of a pregnancy-screening and neonatal-immunization program for hepatitis B in Hamilton, Ontario, Canada, 1977-1988.

During the 12 years from January, 1977, to December, 1988, the Hamilton Centre of the Canadian Red Cross Society (CRCS) Blood Transfusion Service screened 98,712 pregnant patients for hepatitis B surface antigen (HBsAg) and identified 120 positives (0.12%). The number of positives ranged from six to 16 per year. We were able to trace and enroll 65 mothers (54%) and 96 of their children in the follow-up study. The majority of the women were between 20 and 30 years of age (95.4%) and married (86%), and about one-half were employed outside the home. Sixty-five percent were white and 34% Asian, and 20 countries were listed as their places of origin. Hepatitis B immune globulin (HBIG) was available for neonatal immunization since 1977 and combined with vaccine since 1982. Of the 96 candidates for HBIG, 60 (63%) received HBIG within 24 hr, one after 3 months, four unknown, and 31 did not receive it. Of the 56 candidates for vaccination from 1982 to 1989, 26 (46%) received three doses, seven had two doses, eight had one dose, one was unknown, and 14 had none. HBsAg tests were performed on 69 children (71.8%) and anti-HBs on 61 (63.5%). Four of the children are HBsAg positive, 31 have anti-HBs, and 31 have no detectable antibodies. All four HBsAg positives had not received vaccine, and only one had received HBIG. Of the children positive for hepatitis B surface antibodies, five had received no immunization and therefore had been subclinically infected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Detection of hepatitis B virus DNA in the serum of Canadian hepatitis B surface antigen negative, anti-HBc positive individuals, using the polymerase chain reaction.

Continuing hepatitis B virus (HBV) infection is normally associated with the presence of hepatitis B surface antigen (HBsAg) in the serum. In spite of sensitive screening assays for HBsAg, rare cases of post-transfusion HBV infection are still observed. Antibody to hepatitis B core antigen (anti-HBc) often indicates remote HBV infection but DNA hybridisation and more sensitive polymerase chain reaction (PCR) assays have demonstrated that some HBsAg negative individuals, positive for anti-HBc, have continuing HBV replication. To determine the incidence of ongoing HBV infection in a Canadian HBsAg negative, anti-HBc positive population we studied three groups with this combination of HBV markers: Group A, 36 patients referred for investigation of raised serum aminotransferases; Group B, 21 Canadian Red Cross blood donors; Group C, seven vaccinees in an Ottawa Health Care Student hepatitis B vaccination programme. The PCR was carried out using a nested PCR reaction with primers specific for the pre-core region of HBV. Seven of 36 (19%) patients in Group A had detectable HBV DNA whereas none of Group B or C were positive. This data indicates that in some HBsAg negative patients with ongoing hepatic inflammation, continuing HBV replication may persist. This was not observed in any healthy blood donors or health care students investigated. Larger studies are required, but this data would suggest that, in Canada, the addition of anti-HBc testing for all blood donors for detection of low level HBV replication would not be indicated.

Base Sequence↗
PubMed1989

[A new case of allo-anti-LWab].

A patient admitted to hospital for hip replacement was found incompatible in pretransfusion testing due to allo-anti-LWab antibody, as well as anti-JKb, anti-E and anti-IH antibodies. The patient had a rare phenotype LW(a-b-ab-). The antibodies were acquired though pregnancy and/or transfusion. This newly discovered anti-LWab allowed us to study and emphasize the relevant serological and transfusional aspects related to incompatibility caused by "public" antibodies in association with other alloantibodies. We attempted to update the LW system in the light of Sistonen and Tippett's recent discoveries. We collected the required compatible units of blood through autologous donations and a Central Canadian Red Cross Registry for rare donors.

Aged↗
PubMed1997

Varicella zoster antibodies after herpes zoster, varicella and multiple sclerosis.

BACKGROUND: We previously showed that Manitoba Hutterites seek physician care for varicella zoster virus infection significantly less than non-Hutterites. The current study was undertaken to measure varicella zoster virus seroprevalence for Hutterite and non-Hutterite controls. METHODS: Blood was obtained from 315 Hutterites and 259 similar age and sex controls at the time of blood donations to The Canadian Red Cross Society. The controls were from the same or a contiguous postal code area and were collected at the same time as the Hutterite samples. The immune status of the specimens was determined by the ELISA method (enzyme linked immunosorbent assay). RESULTS: Twenty-eight per cent of 315 Hutterites had no immunity and an additional 25% had only marginal immunity. Among the 259 controls, 10% had no immunity and an additional 10% had only marginal immunity (p < .0001). CONCLUSIONS: Manitoba Hutterites have significantly decreased seroprevalence to varicella zoster virus infection. This study of serum varicella zoster virus antibodies verifies a previous population based study that demonstrated the relative rarity of varicella and herpes zoster among a particular population group.

Adult↗
PubMed2001

Reduction of donor exposures in premature infants by the use of designated adenine-saline preserved split red blood cell packs.

OBJECTIVE: Critically ill neonates frequently require multiple small volume red blood cell (RBC) transfusions. RBC units assigned to individual infants, used sequentially in small aliquots until the original expiration date, can substantially reduce donor exposures. In 1993, adenine-saline solution (AS-3) was introduced by the Canadian Red Cross as the red cell storage medium to replace citrate-phosphate-dextrose-adenine anticoagulant-preservative solution (CPDA-1). We surveyed the safety and efficacy of using AS-3 split packs, stored up to 35 days, for premature infants. STUDY DESIGN: Units of packed cells were aseptically welded to three satellite bags using a sterile connecting device. When blood was requested for a small volume transfusion, the first satellite bag was used and the others were set aside for the same baby, for use up until their expiration date of 35 days. RESULTS: Over a 1-year period, 56 infants received a total of 263 AS-3 transfusions from 97 donors, with a mean of 4.7 transfusions and 1.7 donor exposures per infant. Following a 7-ml/kg RBC transfusion, mean rise in hematocrit (hct) was 0.04, regardless of the age of the unit, mean change in serum potassium was -0.16 mmol/l and mean change in total bilirubin was +1.86 micromol/l. The posttransfusion hct was not reduced with the use of the older red cell packs. CONCLUSION: Designated AS-3-preserved split RBC packs effectively limit donor exposures, can safely be used for neonatal small volume transfusions, and give a constant transfusion effect after up to 35 days of storage.

Adenine↗
PubMed1994

Reappraisal of optimal hemoglobin standards for female blood donors in Canada.

BACKGROUND: A hemoglobin (Hb) standard of 115 g per L on the copper sulfate test has been in use by the Canadian Red Cross Society Blood Services for female blood donor predonation screening since 1989. STUDY DESIGN AND METHODS: To determine if this lowered Hb standard results in increased iron deficiency in repeat blood donors, a study was conducted to evaluate the performance of the copper sulfate test and predonation capillary and venous Hb assays in a population of female blood donors most at risk of developing iron deficiency. RESULTS: Of the 174 donors who were of childbearing age, who were not taking iron supplements, and who had made at least three blood donations per year, 45 (25.9%) were iron deficient, and 64 (36.8%) had reduced iron stores; only 65 (37.3%) had normal iron stores. This study showed that capillary blood is more likely to have a higher Hb concentration (3.2 +/- 7.8 g/L) than venous blood samples, which could affect the performance of predonation screening assays that are based on capillary blood samples at a given discriminating value. With an Hb standard of 115 g per L, both the copper sulfate and capillary Hb assays were not sensitive enough to screen for iron deficiency (sensitivity, 27% and 33%; specificity, 96% and 93%, respectively) and were comparable only to the performance of a venous Hb assay with a cutoff value of 110 g per L (sensitivity, 27%; specificity, 99%). In contrast, an Hb standard of 125 g per L in the copper sulfate test could achieve a more optimal sensitivity of 79 percent and specificity of 78 percent. CONCLUSION: This study supports the use of a higher Hb cutoff value of 125 g per L for female blood donors in the predonation fingerstick copper sulfate test.

Adult↗
PubMed1982

Hepatitis B surveillance: 4-year survey of staff in a National Blood Transfusion Service.

The prevalence of HBsAg and anti-HBs in personnel of the Canadian Red Cross Blood Transfusion Service (BTS) during 1979 was not found to be significantly different from that of staff first employed in 1978-1979 or from that found among voluntary blood donors. Between 1976 and 1979, 2525 individuals were tested, of whom 13 seroconverted to HBsAg-positive; 54% of these cases appeared to be accident-related. During the same period 29 staff developed anti-HBs; of these 21% were apparently accident-related. Actual rates of seroconversion were not calculated because of staff turnover. The data suggest that BTS employees do not constitute a 'high-risk' group.

Blood Banks↗
PubMed1996

Detection of hepatitis C virus by PCR in second-generation enzyme immunoassay-seropositive blood donors by using matched pairs of fresh frozen plasma and pilot tube sera.

Between April 1993 and March 1995, 429 of 334,454 (0.13%) blood donations at the Toronto Centre of the Canadian Red Cross were reactive for hepatitis C virus (HCV) by second-generation enzyme immunoassay (EIA-2). Of the 429 EIA-2-positive donations, 189 (44%), 138 (32%), and 102 (24%) were positive, indeterminate, and negative by Second-Generation Recombinant Immunoblot Assay (RIBA-2). To assess HCV viremia and minimize the risk that specimen handling affected PCR-based detection, the qualitative AMPLICOR HCV test was performed on both pilot tube sera (PTS) and the corresponding fresh frozen plasma (FFP) from 294 EIA-2-reactive donations. AMPLICOR PCR results for PTS and FFP were 100% concordant and were confirmed by nested HCV PCR for 27 of 294 donations. The AMPLICOR HCV test was positive for 127 of 140 (91%) of RIBA-2-positive donations (81, 91, and 96% of donations with two, three, and four reactive bands, respectively), 5 of 88 (5.7%) indeterminate donations, and 0 of 66 (0%) RIBA-2-negative donations. The Third-Generation Recombinant Immunoblot Assay (RIBA-3) was performed on RIBA-2-negative, -indeterminate, and -positive, PCR-negative donations. RIBA-3 demonstrated enhanced specificity and resolved 18 of 88 (20%) of RIBA-2-indeterminate samples as HCV antibody positive. The study demonstrates that PTS are as suitable as FFP for PCR-based detection of HCV and can be used to determine if EIA-2-reactive blood donors are viremic at the time of donation.

Blood Donors↗
PubMedDate not supplied

Profile of a leader: Margaret Mary Hunter CM, CStJ, CD, RN.

Margaret Mary Hunter (1918-1991) was Chief Nursing Officer for the St.John Ambulance Association from 1965-1981. She vigorously promoted the Association's Home Nursing course believing every Canadian household should have some one trained in home nursing. Her greatest achievement came in 1976 when, at her initiative, the Department of National Health and Welfare awarded 1,000,000 dollars jointly to the Association and the Canadian Red Cross Society to develop the multi-media program "There' s No Place Like Home for Health Care". Unfortunately this award-winning instructional program was never widely implemented and, following her retirement, home health care training in the Association declined in importance. Margaret Hunter's efforts to effect change illuminate the complex challenges facing nursing leaders of all generations.

Ambulances↗
PubMed1987

Juvenile chronic arthritis.

Juvenile Chronic Arthritis is a relatively uncommon childhood disease. There are no absolute diagnostic tests and many classification criteria have evolved (4, 15, 7) based variably on joint number, disease course, associated clinical features and rheumatoid factor seropositivity. These are of no help diagnostically, but do allow investigative and follow-up studies to compare like with like. It is generally accepted that there are three main modes of onset, the commonest being pauci-articular with less than five joints in the first 3 to 6 months. Arising from the population immediately around the old MRC rheumatism unit at the Canadian Red Cross Memorial Hospital, Taplow, this accounted for 68%, with a poly-articular onset in 20% and systemic onset in 12%. Despite this low incidence of systemic illness, it remains a great challenge.

Adolescent↗
PubMed1975

Hepatitis B antigen in Montréal blood donors: childhood institutionalization as an epidemiologic factor.

In 1971 the Canadian Red Cross blood tranfusion service instituted routine screening for HBAg of all blood donors, using nationwide a standardized counterimmunoelectrophoretic technique. The prevalence of carriers in the Province of Québec is unusually high (0.51%), being 3 to 12 times higher than in the other nine provinces. Among the carriers found in the Montréal area 289 volunteered to be seen by our group for an extensive interview and a series of laboratory tests. There were 243 men and 46 women; their ages ranged from 18 to 55, 90% being less than 40. Twenty-nine were of foreign origin and 260 were born in Canada. The epidemiologic data revealed that the reservoir of HBAg carriers among the blood donors of the Montréal area was found predominantly in the autochthonous population of French origin. Moreover, it appeared that 149 (52%) had lived in institution when they were infants or children: 127 were orphans and had been placed in institutions as newborns or babies, and 22 others had lived in institutions for at least 1 year between the ages of 5 and 10. This was by far the most important single epidemiologic factor that could contribute to the explanation of the abnormally high prevalence of HBAg carriers in the population studied.

Adolescent↗
PubMed1989

Universal prenatal screening for hepatitis B, Alberta, 1985-1988.

A cooperative effort to identify all newborn infants at risk of acquiring hepatitis B infection involving the Canadian Red Cross BTS, Health Units, hospitals, and private doctors has been in place in Alberta since 1985. Routine universal screening of all prenatal patients identifies just under 200 infected mothers per year and about 90% of their infants receive HBIG and HB vaccine in a timely manner and are protected against infection and becoming hepatitis B carriers. At least half of these infants would not be identified if a selective testing program was in place and the cost for this much less efficient policy would be at least 4 times higher. The cost per infant protected through the universal screening program is estimated to be less than $1275. Routine screening of prenatal patients for HBsAg in a public health-coordinated program is highly cost effective and efficient. It is recommended that all jurisdictions consider such a program as recommended by the ACIP unless the hepatitis B carrier state is known to be extremely rare.

Alberta↗
PubMed1977

Exogenous bacterial contamination of donor blood.

The Canadian Red Cross blood transfusion service has followed a set protocol for phlebotomy and collection of a unit of blood. Recent requirements for automated testing have necessitated that a second tube of blood be obtained from the blood line following collection of the unit. Evaluation of the techniques used, however, has indicated the possibility of bacterial contamination from the skin of donors, from insertion of the needle through an unsterile rubber stopper, and through backflow from a nonsterile vacuum tube. To test these possibilities swabs were taken from skin and stoppers of vacuum tubes. Further, vacuum tubes were deliberately contaminated with Escherichia coli. The normal sampling procedure, which involves stripping the donor line to refill and mix the blood, was then followed. This resulted in contamination of the segments and even the blood bag. These findings led to modification of the standard bleeding technique, whereby stripping was eliminated and sterile vacuum tubes were to be used at all times.

Antisepsis↗
PubMed1987

Registry of unrelated bone marrow donors.

Reports of successful transplantation of bone marrow obtained from unrelated donors who were histocompatibility leukocyte antigen (HLA) identical prompted the Canadian Red Cross Blood Transfusion Service in Ottawa to assess the possibility of developing a bone marrow donor registry in Canada. We sent a pamphlet that explained the program to 1568 people who had undergone apheresis and asked them to reply, stating their interest. At the same time the pamphlets and a poster were placed in the blood donor clinic. We received 1232 replies (78.6%) from the apheresis donors, 838 (68.0%) of which indicated a willingness to attend information sessions. Of the 7158 people who gave blood during the 3-month study period, 225 (3.1%) were interested. At the time this paper was written 47 information sessions had been held, and 721 people had attended, 624 (86.5%) of whom had signed a consent form. This indicates a clear interest in a bone marrow donation program. We believe that the ethical issues are overcome by requesting the donation before identification of any patient. From our experience a national registry of unrelated donors seems feasible, and steps are being taken to implement such a program.

Blood Component Removal↗